Syncope with a Deadly Ekg

33 male-smoker, denies cocaine use or family history of sudden cardiac death, presents to the ED with dry cough, chills, myalgias x 1 week now complicated by one episode of syncope one-night prior without any chest pain, palpitations, SOB, incontinence. After having LOC, he awoke, crawled into bed and went to sleep. The next dayRead more

About Those Alcohol Levels…

Thanks to Dr’s Strayer and Desai for inspiring today’s pearl: We are generally comfortable with the serum alcohol levels reported by the Sinai/EHC labs, but how does this compare to the legal limits you hear about (0.08, etc), breathalyzer tests, or the measurments used in other countries? Blood alcohol concentration (BAC) is  measured as aRead more

Use of Permacath for Iv Access

54F history of hypertension, diabetes, and ESRD presents to your Emergency Department hypotensive and febrile, nurses are hunting for IV access and unable to obtain any peripheral access, what can you do for access?     Answer: Use the Permcath 1. identify blue port 2. remove blue cap, withdraw and waste 5 mL (tubing mayRead more

Extra-cardiac Ecg Manifestations

These days, it’s hard to come to the ED and not get an ECG. Sometimes that stubbed toe will have early repol and you’ll wonder why the ECG was done; but some other times a ECG may provide some clues for a diagnosis you may not otherwise have suspected. For today’s pearl I’m going toRead more

50yo Man with Chest Pain…and Also with R Ear Pain

Today’s pearl is on the sexy topic of cerumen disimpaction, make that evidence-based cerumen disimpaction! So you’re working adult/peds/fast track and the patient who is there for chest pain/fractured hand/URI reports during your thorough ROS that he also has right ear pain and decreased hearing for two weeks. You take a peek, and you encounterRead more

2013 St Luke’s Roosevelt Regional Ultrasound Symposium

    This symposium is always worth the trip.  See you there.Read more

14yo Girl with Leg Weakness

Case courtesy of Dr. Jenny Sanders. 14F woke up this morning and collapsed due to leg weakness while on her way to the bathroom; is able to crawl but can’t walk; has some tingling in her LE. Was in usual state of health the day before. No sig medical or psychiatric history. Had a runnyRead more

Chest Pain After Endoscopy

46F sent from GI after undergoing endoscopy with biopsy for an esophageal mass, the patient had acute onset of substernal chest pest pain and was transferred to the ED for evaluation. EKG is normal. Chest x-ray is pending. The patient has stable vitals, maintaining her airway. On exam, the patient is uncomfortable, but otherwise noRead more

Introduction to Bedside Ultrasound

  It’s been out awhile now, but if you haven’t seen it yet, take a look at Mike and Matt’s Introduction to Bedside Ultrasound.  The ultrasound pocast guys have released this excellent overview of point of care ultrasound through the iTunes Store.  This is certainly convenient as most of us have 3-12 iDevices on ourRead more

Lung ultrasound goes viral for flu season

More lung ultrasound tips and examples from Drs. Jim Tsung and Brittany Pardue Jones! Bacterial pneumonia will manifest as lung consolidation with air bronchograms. The A-line pattern of normal lung will begin to be replaced by B-lines in the area of affected lung: Here we’ve highlighted the consolidation from the above video as well: In contrast, subpleuralRead more